RESUMO
AIMS: Data on long-term follow-up of patients with Chagas' heart disease (ChHD) receiving a secondary prevention implantable cardioverter-defibrillator (ICD) are limited and its benefit is controversial. The aim of this study was to evaluate the long-term outcomes of ChHD patients who received a secondary prevention ICD. METHODS AND RESULTS: We assessed the outcomes of consecutive ChHD patients referred to our Institution from 2006 to 2014 for a secondary prevention ICD [89 patients; 58 men; mean age 56 ± 11 years; left ventricular ejection fraction (LVEF), 42 ± 12%]. The primary outcome included a composite of death from any cause or heart transplantation. After a mean follow-up of 59 ± 27 months, the primary outcome occurred in 23 patients (5.3% per year). Multivariate analysis showed that LVEF < 35% [hazard ratio (HR) 4.64; P < 0.01] and age ≥ 65 years (HR 3.19; P < 0.01) were independent predictors of the primary outcome. Using these two risk factors, a risk score was developed, and lower- (no risk factors), intermediate- (one risk factor), and higher-risk (two risk factors) groups were recognized with an annual rate of primary outcome of 1.4%, 7.4%, and 20.4%, respectively. A high burden of appropriate ICD therapies (16% per year) and electrical storms were documented, however, ICD interventions did not impact on the primary outcome. CONCLUSION: Among ChHD patients receiving a secondary prevention ICD, older age (≥65 years) and left ventricular dysfunction (LVEF < 35%) portend a poor outcome and were associated with increased risk of death or heart transplantation. Most patients received appropriate ICD therapies, however, ICD interventions did not impact on the primary outcome.
Assuntos
Cardiomiopatia Chagásica/mortalidade , Cardiomiopatia Chagásica/terapia , Desfibriladores Implantáveis , Transplante de Coração , Taquicardia Ventricular/mortalidade , Taquicardia Ventricular/terapia , Idoso , Feminino , Seguimentos , Transplante de Coração/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Prevenção Secundária , Volume SistólicoRESUMO
A 12-year-old child with end-stage heart failure due to restrictive cardiomyopathy was submitted to orthotopic heart transplantation. Primary graft dysfunction required venous arterial extra-corporeal membrane oxygenation. Heart function normalized, but complete atrioventricular block remained after 3 weeks. A dual-chamber pacing with transvenous left ventricle pacing through the coronary sinus was performed. At 5-year follow-up, the patient is stable with the same pacing system and with preserved ventricular function.
Assuntos
Bloqueio Atrioventricular/terapia , Transplante de Coração/efeitos adversos , Marca-Passo Artificial , Disfunção Primária do Enxerto/complicações , Bloqueio Atrioventricular/etiologia , Criança , Seio Coronário , Feminino , Insuficiência Cardíaca/cirurgia , Ventrículos do Coração , Humanos , Disfunção Primária do Enxerto/terapiaRESUMO
AIMS: Evidence is inconclusive concerning the benefit of implantable cardioverter-defibrillators (ICDs) for secondary prevention of mortality in patients with Chagas' heart disease (ChHD). The aim of this study was to compare the outcomes of ChHD patients with life-threatening ventricular arrhythmias (VAs), who were treated either with ICD implantation plus amiodarone or with amiodarone alone. METHODS AND RESULTS: The ICD group [76 patients; 48 men; age, 57 ± 11 years; left ventricular ejection fraction (LVEF), 39 ± 12%] and the historical control group treated with amiodarone alone (28 patients; 18 men; age, 54 ± 10 years; LVEF, 41 ± 10%) had comparable baseline characteristics, except for a higher use of beta-blockers in the ICD group (P < 0.0001). Amiodarone was also used in 90% of the ICD group. Therapy with ICD plus amiodarone resulted in a 72% reduced risk of all-cause mortality (P = 0.007) and a 95% reduced risk of sudden death (P = 0.006) compared with amiodarone-only therapy. The survival benefit of ICD was greatest in patients with LVEF < 40% (P = 0.01) and was not significant in those with LVEF ≥ 40% (P = 0.15). Appropriate ICD therapies occurred in 72% of patients and the rates of interventions were similar across patients with LVEF < 40% and ≥40%. CONCLUSION: Compared with amiodarone-only therapy, ICD implantation plus amiodarone reduced the risk of all-cause mortality and sudden death in ChHD patients with life-threatening VAs. Patients with LVEF < 40% derived significantly more survival benefit from ICD therapy. The majority of ICD-treated patients received appropriate therapies regardless of the LV systolic function.
Assuntos
Ritmo Idioventricular Acelerado/terapia , Amiodarona/uso terapêutico , Antiarrítmicos/uso terapêutico , Cardiomiopatia Chagásica/terapia , Morte Súbita Cardíaca/prevenção & controle , Desfibriladores Implantáveis , Fibrilação Ventricular/terapia , Ritmo Idioventricular Acelerado/etiologia , Adulto , Idoso , Cardiomiopatia Chagásica/complicações , Morte Súbita Cardíaca/etiologia , Feminino , Estudo Historicamente Controlado , Humanos , Masculino , Pessoa de Meia-Idade , Prevenção Secundária , Índice de Gravidade de Doença , Volume Sistólico , Taquicardia Ventricular/etiologia , Taquicardia Ventricular/terapia , Resultado do Tratamento , Fibrilação Ventricular/etiologiaRESUMO
A 63-year-old diabetic woman was emergently submitted to coronary artery bypass grafting in the setting of acute myocardial infarction. Recurrent, drug-refractory episodes of ventricular arrhythmia occurred for 2 weeks postoperatively, despite no documentation of ongoing myocardial ischemia and optimum medical treatment. Ventricular arrhythmia was initiated by premature ventricular contractions originating from the Purkinje system within the infarct border zone. Radiofrequency catheter ablation was performed at sites where Purkinje potentials were recorded, leading to arrhythmia cessation. A week later, an implantable cardioverter defibrillator was inserted and she was discharged home a few days later. At 15-month follow-up, there were no further episodes of arrhythmia and ventricular function had improved.